Cervicogenic Headache is Rare – You Have Got to be Kidding (?)

October 7, 2009 by dean · Leave a Comment 

In a study coming out of Norway the incidence of cervicogenic (neck) headache was found to be rare – only 0.17% of the population.

It is interesting to note that the diagnosis was made based only on the features of headache. It is widely accepted that features of headache alone are not sensitive enough to differentiate cervicogenic headache from migraine and from tension headache.

To diagnose cervicogenic headache, a thorough and skilled examination of the upper neck needs to be performed for temporary reproduction (and resolution) of familiar headache.

A physical examination was performed on only those headache sufferers selected on the basis of their headache features (and did include the above!). If it had it would have confirmed cervicogenic headache. However this is not the point, the physical examination was performed on only a select few!

Similarly, greater occipital nerve (GON) blocks blocks were performed only on those selected from their headache features – the blocks were effective in over 90% – I am not surprised. As with the physical examination, the blocks needed to be performed before a diagnosis of cervicogenic headache was made.

I have written before of the numerous studies demonstrating that headaches with a diagnosis of migraine are relieved by blocking the GON (greater occipital nerve) – who knows how many of the headache sufferers were excluded based on features and who had cervicogenic headache (?)

Previous research has shown that cervicogenic (neck) headache is as common as migraine.

Cheers

Dean

(Knackstedt H. Cervicogenic headache in the general population. the Akershus study of chronic headache. Cephalalgia 2009;29 (Suppl. 1):1–166

Nilsson N. The prevalence of cervicogenic headache in a random population sample of 20-59 year olds. Spine 1995;20:1884-1888

Rozen T. Cessation of hemiplegic migraine auras with greater occipital nerve blockade. Headache 2007;47:917-928

Takmaz, S. et al Greater occipital nerve block in migraine headache: Preliminary results of 10 patients. Agri 2008 Jan;20(1):47-50

Yi X et al Cervicogenic headache in patients with presumed migraine: missed diagnosis or misdiagnosis? J Pain. 2005 Oct;6(10):700-3

Young WB, Marmura M, Ashkenazi A, Evans RW. Expert opinion: Greater occipital nerve and other anesthetic injections for primary headache disorders. Headache. 2008;48:1122-1125

Young et al. The first 5 minutes after greater occipital nerve block. Headache 2008;48:1126-1139)

© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.

Neck Disorders in Migraine and Chronic Migraine Headache

October 1, 2009 by dean · Leave a Comment 

Neck Disorders are frequently found in migraine sufferers

Neck Disorders are frequently found in migraine sufferers

More evidence from a study in the US which shows that cervicogenic (neck) disorders are frequently found in Migraine and Chronic Migraine sufferers.

Using a special device, muscle tenderness was assessed and found to be significantly increased in both the migraine and chronic migraine groups when compared to non headache subjects.

Why is it that the conclusion was that muscle tenderness results from the migraine process and not the cause of the process?!!!

Cheers  Dean

(Bevilaqua-Grossi D, Moreira VC, Canonica AC, Chaves TC, Goncalves MC, Florencio LL, Bordini CA2, Speciali JG, Bigal ME. Pain thresholds in craniocervical muscles in women with migraine, chronic migraine, and with no headaches. Cephalalgia 2009;29 (Suppl. 1):1–166)

© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.

Waking With Headache or Migraine is as a Result of Neck Position

September 28, 2009 by dean · Leave a Comment 

Check your pillow if you wake with headache

Check your pillow if you wake with headache

In a recent survey of over 1000 adults it was found that 5% (48) reported waking with headache, problems staying asleep and regular use of sleep medication, and wait for it … difficulties staying awake and falling asleep unwillingly during the day! Wouldn’t we all if we had not had a good nights sleep or still under the influence of sleep medication!

If you are waking with headache then you may need to check your pillow of the number of your pillows. As a clinician it is not easy to advise on pillows as we are all different sizes and shapes; many of my patients have a number of pillows gathering dust in the wardrobe as they go about the eternal search for the ideal pillow!

I find the best approach is to use a soft pillow – something like a feather and down pillow which fits you, rather than forcing you to fit it – unlike many of those foam shaped pillows – too bad if your neck is not the same shape as the pillow! I tried one once and it gave me headache!

Cheers

Dean

(Seidel S, Kloch G, Moser DC, Zeitlhofer J, Wober C Morning headaches are related to sleep problems and poor daytime functioning – a population-based controlled study Cephalalgia 2009;29(Suppl. 1): 1–166)

© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.

How You Can Escape The Pain of Headache

September 20, 2009 by dean · Leave a Comment 

The article “How You Can Escape The Pain of Headache And Get Your Life Back … Now!” outlines the first step – to identify the source of your headache.

Go to ‘Articles’ on the ‘Home Page’ and scroll down before clicking on the article title to be taken straight to it or click on …

Cheers

Dean

© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.

Migraine And Cluster Headache Are ‘First Cousins’!

September 19, 2009 by dean · Leave a Comment 

Migraine sufferers experience many symptoms

Migraine sufferers experience many symptoms

As I have mentioned in many of my previous reports, my clinical experience agrees with the research which shows that the many different forms of headache and migraine share the same ‘heritage’ or disorder i.e. a sensitised brainstem.

This recent study which surveyed 76 Cluster Headache sufferers showed that nausea, vomiting, photophobia and phonophobia were reported by 41%, 24%, 49% and 46% respectively of the patients. Aura occurred in 28% of the patients and visual symptoms were reported most frequently.

Those of you who are migraine sufferers will be familiar with the symptoms mentioned above (!)

This is further evidence supporting a common, shared mechanism for headache and migraine.

Cheers

Dean

(Wober C and Knopf A. Migrainous features in cluster headache. Cephalalgia 2009;29 (Suppl. 1):1–166)

© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.

Cluster Headache Eased By Treating Cervicogenic (Neck) Disorders

September 17, 2009 by dean · Leave a Comment 

Cluster Headache is a severe, nasty, form of headache

Cluster Headache is a severe, nasty, form of headache

Cluster Headache is a very severe, nasty, form of headache which is often unresponsive to traditional (typically medication) treatments.

My clinical experience (examining the upper neck) comprising temporary reproduction of headache and also of the associated features i.e. watery eye, blocked, congested or runny nostril, and subsequent successful treatment, suggests that cervicogenic disorders can be responsible for this debilitating type of headache.

Cluster headache sufferers who either could not tolerate the side effects of the medication or their headaches were not responsive to medication, responded to blocking information from structures (joints, ligaments, muscles etc) of the upper neck. These studies support my clinical experience and my claim that the upper necks of cluster headache sufferers should be examined for relevant disorders.

Cheers

Dean

(Gaul C, Muller O, Gasser T, Diener H-C, Katsarava Z. Bilateral occipital nerve stimulation for chronic cluster headache. Cephalalgia 2009;29 (Suppl. 1):1–166

Lara Lara M, Paz Solis J, Ortega-Casarubios MA, Palao , Tarrero A, Heredero J, Diez-Tejedor E. Occipital nerve stimulacion: is peripheral approach effective in cluster headache? Cephalalgia 2009;29 (Suppl. 1):1–166)

© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.

Cluster Headache In 2 Year Old Girl!

September 13, 2009 by dean · Leave a Comment 

Cluster Headache in 2.5 year old

Cluster Headache in 2year old

This is amazing!

Whilst I have treated a 3 year-old girl with ‘migraine’ (i.e.one-sided headache with nausea and vomiting) I have never come across this before.

The authors describe that it was difficult to make a diagnosis in such a young patient (given that in adults it is fraught with difficulty!) due to the lack of patient’s inability to describe symptoms well. However it appears that it was the associated symptoms (redness of the eye, tearing of the eye, swelling of the eyelid and itching of the nostril) which enabled a clear diagnosis of cluster headache to be made.

Cheers

Dean

(M Kacinski, A Nowak, S Kroczka & A Gergont. Cluster headache in 2-year-old Polish girl. Cephalalgia 2009;29:1091-1094)

© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.


A Thorough Examination of Your Neck

September 9, 2009 by dean · Leave a Comment 

A skilled examination of the neck

A skilled examination of the neck

A thorough examination of your neck by a skilled practitioner may be the missing link in finding the root cause of your headache or migraine.

It is appropriate that the first step is for your headache or migraine to be assessed by your doctor who will then determine if a neurological opinion is required and whether a scan of your head is necessary. In the vast majority of cases a scan is negative, that is, no abnormality is present. Subsequently, what usually happens is that medication is suggested, and then starts a ‘merry-go-round’ of trying different medication regimes; you as a headache or migraine sufferer are (perhaps unnecessarily) destined to a lifetime of medication.

At this point, what is missing is a thorough examination of the structures of the upper neck.

Cheers

Dean

© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.

Hemicrania Continua – The Challenges of Diagnosis!

September 7, 2009 by dean · Leave a Comment 

One Sided Headache

A Constant One Sided Headache

Hemicrania continua is defined as a constant one sided (and always on the same side) headache of moderate intensity with exacerbations and which responds to Indomethacin. Other possible symptoms include redness of the eye, a watery or teary eye, a blocked or runny nostril and drooping of the eyelid.

But we have case reports which show that this supposedly one sided (always the same side) headache can occur on the other side and can also be on both sides at the same time.

Interestingly the traditional classification system of headache and migraine states that Cervicogenic (neck-related) Headache as a one sided headache (and always the same side) also. However my experience of over 21000 hours with headache and migraine patients is that a one sided headache that can occur on the other side is a Cervicogenic Headache. Does this mean that I am saying Hemicrania Continua is likely to be Cervicogenic Headache – Yes!

Cheers

Dean

(Headache Classification Subcommittee of the International Headache Society. The International Classification of Headache Disorders, 2nd edn. Cephalalgia 2004; 24(suppl.1):1-151

Marano E, Giampiero V, Gennaro DR, di Stasio E, Bonusa S, Sorge F. ‘Hemicrania continua’: a possible case with alternating sides. Cephalalgia 1994; 14:307–8.

Matharu MS, Boes CJ, Goadsby PJ. Management of trigeminal autonomic cephalalgias and hemicrania continua. Drugs 2003; 63:1637–77.

Matharu MS, Bradbury P, Swash M. Hemicrania continua: side alternation and response to topiramate. Cephalalgia 2005; 26: 341-344

Newman LC, Lipton RB, Russell M, Solomon S. Hemicrania continua: attacks may alternate sides. Headache 1992; 32:237–8.

Newman LC, Spears RC, Lay CL. Hemicrania continua: a third case in which attacks alternate sides. Headache 2004; 44:821–3.

Sjaastad O, Fredricksen TA, Pfaffenrath V. Cervicogenic headache: diagnostic criteria. Headache 1998; 38:442-5)

© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.

‘Hair Wash Headache’!

September 5, 2009 by dean · Leave a Comment 

Weight of hair can pull the upper neck backwards

Weight of hair can pull the upper neck backwards

In recent correspondence to an acclaimed international headache journal, a doctor located in India reported on migrainous headache occurring after washing of the hair – as the author explains this has either not been noticed in other countries or it may be that similar headache presentations in other countries occur but are called something else.

As reported by this doctor, the crucial factor here is that many ladies from India have long hair that is plaited and it is time consuming to dry their hair (it is uncommon to use a hairdryer). Consequently many women do not wet their hair daily. On the days that they wash their hair however they describe throbbing headache developing within 10’-15’ ; their history of these headaches is usually quite long; this is the only headache they get; usage of perfumes or shampoos is uncommon … therefore the author (doctor) considers there are no other triggering factors …..

Are you thinking what I’m thinking? Imagine the weight on the back of the head of all the wet hair pulling the upper neck backwards – the stress on the neck structures would be significant …. could this be an unrecognised cervicogenic headache?

Cheers

Dean

(Ravishanka K. ‘Hair-wash headache’—an unusual trigger for migraine in Indian patients Cephalalgia 2005;(25)12:1184-1185

Ravishanka. Unusual Indian migraine trigger factors. Headache World 2000. Poster Presentation. Cephalalgia 2000; 20:359)

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